Intergenerational Transmission of Child Neglect
(Originally published in UPBRING in 2017)
Neglect is by far the most common type of child maltreatment in the United States; in recent years, almost four-fifths of child victims reported to the National Child Abuse and Neglect Data System (NCANDS) have been neglected compared to one fifth of victims who have been physically abused and less than one in ten victims who have been sexually abused. Neglect is more strongly associated with child poverty than physical abuse or sexual abuse, and is more recurrent than other types of child maltreatment as indicated by CPS re-reports, multiple substantiations or re-entry into care. In its chronic form, neglect is often found in combination with substance abuse, mental health conditions and domestic violence, as well as poverty. During the past two decades, a rapidly expanding body of research has found that the lack of responsive parenting which often accompanies pervasive neglect of young children's basic needs has devastating effects on early brain development and on children's emotional, social and cognitive development.
For decades, scholars remarked on the 'neglect of neglect', a relative lack of interest which extended to study of the intergenerational transmission of neglect. However, in recent years Carolyn Widom and Valentina Nikulina, Jessica Bartlett and Melissa Easterbrooks, Emily Putnam-Hornstein, and other scholars have published research which sheds new light on the intergenerational transmission of both abuse and neglect and which contains some surprising findings:
Neglect is more likely to be transmitted from one generation to the next than physical abuse.
A parent's history of physical abuse in childhood increases the risk of neglectful parenting by a factor of four. A history of physical abuse in childhood is more likely to lead to neglectful parenting than abusive parenting.
The experience of multiple types of maltreatment in childhood greatly increases the risk of intergenerational transmission of neglect.
Most parents neglected or multiply maltreated in childhood do not become neglectful or abusive parents; nevertheless, histories of childhood maltreatment are common among parents who neglect infants.
The frequency and dependability of social support and positive early bonds moderate the effects of child maltreatment histories on parenting in the next generation.
Most of these research findings have not yet been adequately explained by scholars. Nevertheless, plausible hypotheses include: (1) Severe and chronic neglect in early childhood is associated with large “doses” of the adversities found in Adverse Childhood Experiences (ACE) studies to compromise health and mental health over the life span. (2) The combination of material hardship and psychological distress found in chronic neglect and multiple maltreatment is especially toxic to positive child development. (3) Histories of early trauma and neglect undermine the capacity for friendship and intimacy; on the other hand the capacity for positive social relationships is a source of resiliency. (4) Impaired cognitive functioning and early onset mood disorders negatively affect self efficacy in multiple domains. (5) The low academic achievement of neglected and multiply maltreated children leads to low wage employment which frequently results in the intergenerational transmission of poverty.
The intergenerational transmission of neglect can be interrupted through (a) the experience of nurturing caregiving, supportive friendships and intimate relationships, and frequent dependable social support; (b) elimination of severe child poverty and child homelessness; (c) the adoption of trauma-informed practices by social institutions, including schools, child placing agencies and child welfare systems; (d) by screening of children's mental health status and provision of evidenced based mental health practices and programs as early as possible; and (e) commitment to empowerment practices for work with severely and chronically neglected children and their parents, and for communities that have had long histories of oppression.
Modern child protection systems in the U.S. were created in state and federal law during the 1960s and early 1970s due to intense public concern with the severe physical abuse of young children. For the next two decades (at least), the most widely shared hypothesis regarding the cause of physical abuse among scholars and practitioners was that parents abused in childhood often became physically abusive parents; intergenerational transmission of physical abuse was due to social learning which began in a parent’s own childhood. Numerous research studies of this hypothesis produced mixed results, possibly due to differences in definitions of physical abuse, along with varying samples, research designs and measurements, and the questionable assumption that physical abuse was a homogenous phenomenon. In the late 1980s, a highly influential article by Kaufman and Zigler concluded that approximately 30% of abused children became abusive parents (Kaufman & Zigler, 1987). However, many early studies tracked intergenerational transmission of either physical abuse or child maltreatment as a whole. As a result, until recent years there was limited understanding of the intergenerational transmission of child neglect.
As risk assessment systems were developed, a childhood history of abuse or neglect became one of several important risk factors rather than a standalone cause of child maltreatment. Public child
welfare agencies turned their attention to substance abuse, chronic mental health conditions and domestic violence which, together with poverty, were often present in families of young children placed out of the home, frequently due to child neglect. Child welfare scholars seemed to lose interest in developing theoretical frameworks to understand the etiology of child maltreatment, preferring instead to focus on the capacity of risk assessment models to predict child maltreatment absent explanation of its causes.
Abuse and Neglect is a Misnomer
It appears that definitions of child neglect were added to state statutes almost as an afterthought or because of federal CAPTA requirements. Nevertheless, reports of child neglect have far outnumbered reports of physical abuse or sexual abuse from the early years of the modern child protection system; and the differences in percentages of CPS reports alleging neglect vs. various types of abuse have increased during the past decade. Almost four-fifths of victims of child maltreatment have been neglected compared to about one-fifth of victims who have been physically abused and less than one in ten victims who have been sexually abused, according to annual Child Maltreatment reports based on NCANDS data (U.S. Department of Health & Human Services, 2014).
Neglect is more strongly associated with poverty than is physical abuse, sexual abuse or emotional abuse; it is (arguably) high child poverty rates that shape the incidence and prevalence of various types of child maltreatment in the United States. Furthermore, neglect is a more recurrent type of maltreatment than physical abuse or sexual abuse as indicated by rates of CPS re-reports, multiple substantiated reports and rates of re-entry into care. The research of Melissa Jonson-Reid, Brett Drake and Anthony Loman has found that, for families with multiple CPS reports, cross-type recidivism in which allegations of neglect and different types of abuse are combined is the rule rather than the exception (Jonson-Reid et al., 2003; Loman, 2006). Reports of neglect in early childhood are often followed by allegations of physical abuse, sexual abuse or emotional abuse, as well as additional allegations of neglect in chronically reported families. In these families, conditions that eventually lead to abuse appear to first result in early neglect, a pattern
that has not been adequately explained by scholars. These research findings suggest that, for the U.S., it would be more accurate to refer to 'neglect and abuse' than vice versa to underline the prevalence of neglect in both CPS reports and in victimization patterns, and the causal role of neglect in the development of chronic child maltreatment which includes both neglect and one or more types of abuse of children.
Effects of Neglect on Child Development
It used to be common among child welfare scholars to comment on the 'neglect of neglect' in published research and in child welfare agencies' reform initiatives. For decades, the most common type of child maltreatment in the U.S. consistently received the least attention from policymakers, advocates and scholars, possibly because of the relative lack of public concern with the neglect of children compared to the concern with physical abuse or sexual abuse. However, during the past 10-15 years there has been a rapidly expanding body of research published on child neglect, especially regarding its effects on early brain development and on cognitive development, educational achievement, emotion regulation, executive functioning, social relationships and economic outcomes in young adulthood. In 2012, the Center for the Developing Child at Harvard published The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain which summarized this body of research and concluded that severe neglect in a family context “can cause more harm to a young child's development than physical abuse, including subsequent cognitive delays, impaired executive functioning and disruption of the … stress response” (p.2). The extent of developmental harm to a child's emotional, social and cognitive development and the potential for serious lifelong effects on learning, intimate relationships and impulse control appears to lay the foundation for the intergenerational transmission of neglect.
New Research on Intergenerational Transmission
In recent years, there has been a resurgence of scholarly interest in the intergenerational transmission
of child maltreatment. Carolyn Widom and Valentina Nikulina, Jessica Bartlett and Melissa Easterbrooks, Emily Putnam-Hornstein, and other scholars have used longitudinal studies, administrative data bases and other creative sampling strategies to explore the degree of intergenerational transmission of both child abuse and neglect. Some of their findings are surprising and have yet to be adequately explained:
In Carolyn Widom's longitudinal study of children made legally dependent due to child maltreatment in the 1960s, a history of maltreatment in childhood was associated with elevated rates of neglect and sexual abuse, but not physical abuse, in the next generation. Widom's study compared adults with childhood histories of maltreatment to a nonmaltreated control group who grew up in the same neighborhoods and whose families had similar socio-economic profiles (Widom, Czaja, & DuMont, 2015).
In their study of infant neglect among young mothers in a state home visitation program, Jessica Bartlett and Melissa Easterbrooks found that more than three quarters of mothers (77%) who were maltreated in childhood had not maltreated their children by age 30 months. However, “a history of substantiated intergenerational transmission was common”; 60% of mothers of neglected infants were maltreated (in their childhoods) “and the proportion differed significantly by whether mothers did or did not have a history of maltreatment” (Bartlet & Easterbooks, 2015, p. 27).
In Widom's study, parents with histories of childhood maltreatment had rates of CPS reports and out-of-home placements of their children 2-3 times higher than parents in the control group. However, there were only small differences in self-reported child maltreatment behaviors between parents with childhood maltreatment histories and control group parents, suggesting that the surveillance effect may have been partially responsible for higher rates of CPS reports and child placements (Widom, Czaja, & DuMont, 2015).
In Bartlett's and Easterbrooks' study of adolescent mothers, a history of physical abuse in childhood was more likely to lead to neglectful parenting than abusive parenting. Furthermore, mothers abused in childhood were four times more likely to be substantiated for neglect than mothers who had not been physically abused in childhood (Bartlett & Easterbrooks, 2012).
In Bartlett's and Easterbrooks' study of infant neglect, mothers who had experienced multiple types of maltreatment in childhood were 2.5 -3 times more likely to be substantiated for neglect than mothers without a history of maltreatment in childhood (Bartlett & Easterbrooks, 2015).
In Bartlett's and Easterbrook's study of infant neglect, the frequency and dependability of social support moderated the relation between maternal histories of childhood maltreatment and parenting whereas positive relationships in childhood did not. However, in their study of adolescent mothers “positive early bonds help to counteract adversities faced by adolescent mothers…” (Bartlett & Easterbrooks, 2015, p. 2167). Unfortunately, neither of these studies examined the moderating effects of intimate relationships and the presence or absence of domestic violence on young mothers abused or neglected in their own childhoods.
In these studies, (1) neglect was more likely to be transmitted from one generation to the next than physical abuse and (2) a history of physical abuse in childhood was more likely to lead to neglectful parenting than abusive parenting in the next generation. (3) A history of physical abuse in childhood increased the risk of substantiated child neglect by a factor of four. (4) Histories in childhood of multiple types of maltreatment were associated with highly elevated rates of child neglect in the next generation. (5) The frequency and duration of social support and positive bonds with caregivers in childhood had a modest effect on rates of intergenerational transmission of child neglect among young mothers. What are plausible hypotheses for explaining these intriguing research findings?
1. Severe early neglect is associated with multiple adversities, including poverty, co-occurring substance abuse and mental health disorders, domestic violence, and parental incarceration. Adverse Childhood Experiences (ACE) studies have consistently found that it is the number of adversities, rather than any one specific adversity, that has the most effect on health and mental health outcomes throughout adult life (Felitti et al., 1998). The elevated rate of intergenerational transmission of neglect compared to abuse may be due to a higher average “dose” of adversities in childhood for neglected children compared to physically abused children.
2. Nikulina, Widom and Czaja have recently published research that compares adult outcomes for neglected children vs. poor children, not an easy comparison to make given the enmeshment of poverty and neglect (Nikulina, Widom, & Czaja, 2011). They found that both poverty and neglect (independently) were associated with elevated rates of PTSD and arrests in young adulthood and lower levels of academic achievement. Poverty (but not neglect) was associated with an elevated rate of Major Depressive Disorder. These findings suggest that parents who experience both severe neglect and long term poverty in childhood are likely to have lower levels of academic achievement and be highly vulnerable to mood disorders, especially PTSD and major depression. According to Widom and Nikulina, material hardship and psychological distress are linked in neglecting families (Widum & Nikulina, 2012, p. 79); and it appears likely that children who grow up in poor families with parents with chronically relapsing mood disorders often become young adults with low academic achievement, limited economic opportunities and early onset mood disorders resulting from trauma histories.
3. The same combination of poverty, often severe poverty bordering on destitution, and psychological distress as reflected in mood disorders and/or co-occurring substance abuse and mental health conditions associated with chronic maltreatment, i.e., combinations of neglectful and abusive parenting, may also lead to elevated rates of intergenerational transmission of neglect by reducing self efficacy in multiple ways.
4. Experiences of childhood trauma inflicted by caregivers results in elevated rates of mood disorders in adulthood. The most common effect of PTSD, severe and chronic depression, and anxiety is to undermine competent functioning, including parenting. It is very difficult for parents with chronically relapsing mood disorders, for example PTSD combined with depression, to maintain consistent patterns of child care. A key mechanism in intergenerational transmission of all child neglect and chronic maltreatment is mood disorders which often co-occur with substance abuse.
5. All substantiated neglect or self reported neglect is not equal. Some neglected children are more nurtured in childhood than others. Chronic pervasive neglect, histories of multiple maltreatment in childhood and prolonged experience of emotional abuse and neglect have more lasting effects on the capacity for friendship and intimacy than less chronic neglect, supervisory neglect that is not part of a pattern of inadequate care or neglect that begins after a lengthy period of nurturing care in early childhood. Parents who can sustain largely positive relationships with peers, family or romantic partners will be less likely to neglect or abuse their own children.
Stopping the Intergenerational Transmission of Neglect Severe early child neglect frequently leads to a series of consequences that include:
A lack of trust in caregivers that makes it difficult for children to learn to calm down and tolerate stress without “meltdowns”;
The experience of recurrent food insecurity and inability to meet basic needs;
Early onset mood disorders and/or externalizing behavior problems;
Low academic achievement leading to low wage employment and intergenerational poverty;
Elevated rates of delinquency in adolescence and young adulthood; and
Difficulties in maintaining stable and positive social relationships, including both friendships and romantic relationships.
A comprehensive program to derail this dismal cycle of impaired emotional and social development, academic failure and limited economic opportunities would include:
1. A public policy investment in promoting early nurturing relationships between parents and children in high risk families, with a much bigger role for public health approaches in the prevention of child maltreatment;
2. Screening for mental health conditions, especially mood disorders, in low income mothers of young children and widespread availability of evidenced based mental health practices for this population;
3. Screening for early onset mental health disorders in children, and in programs designed to restore normal development;
4. Elimination of severe child poverty, including child homelessness through income support programs and use of housing vouchers;
5. Adoption of trauma informed practices in schools, child welfare agencies and juvenile justice institutions;
6. The use of empowerment practices with traumatized minorities and communities;
7. Supportive programs for youth aging out of foster care to age 25.
Chronic neglect has proven to be a difficult therapeutic challenge which continues to frustrate and baffle child protection programs and a wide range of treatment providers. Recent research indicates that neglect is more likely than physical abuse to be transmitted from one generation to the next, in part because of the severe developmental consequences of early neglect and because of the link in neglecting families between material hardship and psychological distress often resulting from histories of early trauma and/or neglect. Furthermore, neglecting parents often have childhood histories of physical abuse or multiple maltreatment. Experiences of early trauma and combinations of abuse and neglect that undermine the capacity for supportive relationships in late adolescence and young adulthood are more likely to result in neglectful parenting than abusive parenting. Nevertheless, most neglected children do not become neglectful or abusive parents; and it is important to discover how young parents with maltreatment histories who broke the cycle of child maltreatment were able to overcome early adversities.
Interventions that bring more supportive assistance to families with babies and other young children combined with policies that aim to eliminate severe child poverty and child homelessness, and a range of trauma informed practices in this country's social institutions are needed to eliminate the intergenerational transmission of child neglect and chronic child maltreatment that includes both neglectful and abusive parenting.
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